After AF ablation in a patient with elevated stroke risk, what is the recommended post-procedure anticoagulation plan?

• A. Stop anticoagulation after 1 week if sinus rhythm is restored.
• B. Continue anticoagulation for at least 2–3 months, with long-term therapy guided by stroke risk scores and individual factors.
• C. Switch to antiplatelet therapy only.
• D. Continue anticoagulation indefinitely regardless of risk.

Answer: (B)

After AF ablation, the risk of stroke can persist even if sinus rhythm is restored, especially in someone with elevated stroke risk. The early post-procedure period is still a time when clots can form due to transient atrial stunning and remodeling, so a period of therapeutic anticoagulation is advised to protect against thromboembolism. The recommended plan is to continue anticoagulation for at least 2–3 months after the procedure. After that, whether to stop or continue anticoagulation should be guided by the patient’s ongoing stroke risk (as assessed by a score like CHA2DS2-VASc) and individual factors such as bleeding risk and preferences. In someone with elevated stroke risk, long-term anticoagulation is commonly continued. Antiplatelet therapy alone is not as effective for preventing AF-related stroke, and stopping anticoagulation too early or maintaining it indefinitely without consideration of risk is not appropriate.